Incidence of infections with Salmonella enteritidis serotypes in Black and Indian children. A 16-year survey.

A 16-year survey (1960--1975) of Salmonella infections other than typhoid fever in Black and Indian children admitted to King Edward VIII Hospital, Durban, is reported. The 3,393 patients yielded 3,688 Salmonella enteritidis serotypes, mainly typhimurium, johannesburg/duval, manhattan, enteritidis, and senftenberg. Organisms were isolated from one or more of the following: stool, urine, blood, cerebrospinal fluid, liver, sputum, subcutaneous tissue, ear and bone. Patients' ages varied from 1 day to 12 years, with a median age of 8 months. The high incidence of malnutrition, other debilitating diseases and multiple pathogens isolated from many of the patients precluded firm decisions as to the role played by most salmonellae as contributory factors or causes of death.

Patterns of disease in Black and Indian children in Natal.

A statistical study of all admissions to the paediatric unit at King Edward VIII Hospital, Durban, during a 16-year period indicates the disease pattern encountered, and emphasizes the prevalence of preventable diseases, largely the result of malnutrition and infection, which leads to a high mortality, especially in the very young.

Septicaemia in kwashiorkor.

In blood and stool cultures from 90 Black children with kwashiorkor, the commonest organisms isolated were Gram-negative aerobic rods. The mortality rate was highest in the group who developed septicaemia. In patients with negative blood cultures, the outcome was much more favourable, although the majority of them showed evidence of respiratory and/or bowel infections. It is felt that routine antibiotic therapy is advisable in the management of kwashiorkor.

Further experience with mebendazole in the treatment of symptomatic trichuriasis in children.

Mebendazole (methyl-5-benzoylbenzimidazole-2-carbamate: Vermox), a broad spectrum anthelmintic, cured 22 (88%) children with symptomatic trichuriasis when given as a single 6-day course in a dosage of 100 mg twice daily. A further 3 (12%) were cured after a repeat 6-day course of therapy. Thus complete parasite eradication was achieved in all. The administration of an antidiarrheal agent, loperamide hydrochloride (Imodium), appeared to enhance the efficacy of mebendazole. Both drugs were well tolerated and completely free of any toxic effects.

Primary intracranial tumours in Black and Indian children, 1960-1975.

This report of cerebral tumours in 60 children admitted to the medical wards of King Edward VIII Hospital, Durban, shows that cerebral tumour is the commonest solid neoplasm in both Black and Indian children. There is a significantly lower incidence of cerebral tumour in Black children. No difference was apparent in age, sex ratio, site or histological types in our racial groups compared with studies in White children from other parts of the world.

The spectrum of infection and sensitivity of organisms isolated from African and Indian children in a Durban hospital.

A prospective study was undertaken over a period of six months to determine the spectrum of infection, sensitivity of organisms isolated, and suitability of antibiotics chosen in 520 consecutive patients admitted to a paediatric unit. Culture and sensitivity of stool, urine and blood yielded 752 isolates; in 147 cases, more than one pathogen was isolated from the same or different sites. High rates of resistance to chloramphenicol, ampicillin, and kanamycin were seen in salmonellae other than Salmonella typhi, which differed in retaining its original sensitive susceptibility profile. Most Enterobacteria were sensitive to gentamicin. Penicillin-resistance was seen in 9% of meningococci, and several Haemophilus influenzae strains (20%) were resistant to ampicillin. Methicillin-resistance was encountered in 13% of Staphylococcus aureus strains and 17% of pneumococci were resistant to penicillin G. The sensitivity pattern of organisms isolated was probably directly related to widespread use of antibiotics.

Streptococcus pneumoniae resistant to penicillin and chloramphenicol.

Three cases of meningitis and two of septicaemia were caused by pneumococci resistant to the penicillins/cephalosporins and chloramphenicol. No beta-lactamase was demonstrated in any of the organisms. All three patients with meningitis died, but the patients with septicaemia recovered after being given appropriate antibiotic therapy.

Pathogenic mechanisms of a non-agglutinable Vibrio cholerae strain: demonstration of invasive and enterotoxigenic properties.

A non-agglutinable Vibrio cholerae strain isolated from the blood of a child with kwashiorkor and fever was shown to have the potential to invade as well as to produce a toxin resembling cholera toxin.

Tinidazole treatment of acute amebic dysentery in children.

Tinidazole, a recent derivative of the nitroimidazole group of compounds, was able to achieve a cure in 96% of children with acute amebic dysentery when given in three single daily doses of approximately 60 mg/kg of body weight. At a dose of approximately 50 mg/kg the cure rate was only 76%. The drug was well tolerated and completely free from any toxic effects. Tinidazole can confidently be recommended as a very simple and safe form of therapy for amebic dysentery.

Tinidazole in treatment of amoebic liver abscess in children.

Tinidazole as a single drug therapy given in a single dose daily for 5 or 3 days was put to rigorous test in malnourished children. Of 25 children with amoebic liver abscess, 23 were cured. The 2 remaining cases required surgical drainage followed by other amoebicides, one subsequently dying from complicating bronchopneumonia.

Mebendazole in the treatment of severe symptomatic trichuriasis in children.

Mebendazole (methyl-5-benzoylbenzimidazole-2-carbamate), a new broad spectrum anthelmintic, cured 26 (74% out of 35 children) with severe symptomatic trichuriasis. Repeat course of therapy were necessary in some cases. The nine treatment failures all showed large reductions (82-99%) in egg counts. Thus, an overall satisfactory response was obtained in terms of complete parasite eradication in 74%, relief of symptoms in all, and significant reduction in worm load in the failures. In the recommended dosage of 100 mg twice daily for 3 days mebendazole failed to achieve a cure rate of 95% to 100% reported in asymptomatic individuals and those with light infections of Trichuris trichiura. It is probable that measures to control diarrhea before administering mebendazole in an increased, extended, or repreated dosage schedule will achieve a higher cure rate. The drug was well tolerated and completely free from any toxic effects.

Further experience with amoxycillin in typhoid fever in children.

A study of 155 children with typhoid fever proved by blood culture showed that amoxycillin was superior to chloramphenical with regard to clinical and temperature response and relapse and carrier rates. This confirmed the findings of a randomised clinical trial on 200 children with typhoid fever and lends support to the value of amoxycillin in this disease.

Tinidazole in treatment of acute amoebic dysentery in children.

The excellent results obtained in this trial indicate that tinidazole is a drug worthy of extensive evaluation in the treatment of amoebiasis, as three single daily doses is a simple form of treatment. The drug was well tolerated and free from any toxic effects.

Trimethoprim and sulphamethoxazole in typhoid fever in children.

One hundred and three children with proved typhoid fever were treated with trimethoprim-sulphamethoxazole, and the results compared with those of a further 40 children treated with chloramphenicol. The bacteriological response to trimethoprim-sulphamethoxazole was unsatisfactory. From this study it seems that at present chloramphenicol is still the treatment of choice for typhoid fever. In view of the haematological changes occurring during therapy with trimethoprim-sulphamethoxazole caution is necessary and monitoring of the blood picture advisable, even at the recommended dose.